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<html xmlns='http://www.w3.org/1999/xhtml'>
<head>
	<meta http-equiv='Content-Type' content='text/html; charset=utf-8' />
	<meta http-equiv='Content-Language' content='zh-tw' />
	<meta http-equiv='expires' content='-1' />
	<meta name="Description" content="聯絡我們" />
	<title>連絡我們 - Lokema.com.tw</title>
	<style>
	form {background:#4f718a;}
	</style>
	<link href='contact.css' rel='stylesheet' type='text/css' />
	<script type="text/javascript" src="http://jasoninfo.googlecode.com/files/utility.js" charset="utf-8"></script>
</head>
<body>
<br />
<div align=center>
<form name="ApplyForm" id="ApplyForm" method="post">
	<fieldset id="personal">
		<legend>連絡資料</legend>

		<label>姓名 : </label> 
		<input name="姓名" id="姓名" type="text" tabindex="1" />
		<br />
	
		<p>...請提供任一連絡電話(請勿輸入符號，市話請加區碼)...</p>
		<label>行動 : </label>
		<input name="行動" id="行動" type="text" tabindex="2" />
		<br />
		<label>市話 : </label> 
		<input name="市話" id="市話" type="text" tabindex="3" />
	</fieldset>

	<fieldset id="opt">
		<legend>連絡項目</legend>
		<div align=left>
		<select name="項目">
			<option selected="selected" value="方案說明/優惠介紹">方案說明/優惠介紹</option>
			<option value="申請/供裝服務">申請/供裝服務</option>
			<option value="資料異動/移機">資料異動/移機</option>
			<option value="服務停用/退費.">服務停用/退費</option>
			<option value="發票/帳務查詢.">發票/帳務查詢</option>
			<option value="檢修/障礙申告.">檢修/帳礙申告</option>
			<option value="服務使用/設定.">服務使用/設定</option>
			<option value="加入經銷商">加入經銷商</option>
			<option value="廣告/託播">廣告/託播</option>
			<option value="建議事項/其它">建議事項/其它</option>
		</select>
		</div>
	</fieldset>

	<fieldset id="current">
		<legend>留言內容</legend>
		<textarea name="訊息" tabindex="40"></textarea>
	</fieldset>

	<p>
		<input name="ApplyButton" id="ApplyButton" onclick='return ApplyFormCheck();' type="submit" value="送出資料" /> 
		<input name="ResetButton" id="ResetButton" type="reset" value="清除重填" />
	</p>
</form>
</div>
<script type='text/javascript'>
/*var formOBJ = strProcHost+'$kbro/contact.save.asp?key='+getParameterByName('key');*/
var formOBJ = 'http://lokema.tw/$kbro/contact.save.asp?key='+getParameterByName('key');
</script>
</body>
</html>
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